初探R2*值定量评估子宫内膜癌生物学行为的价值

doi:10.12117/jccmi.2019.02.013

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摘要目的：通过研究增强T2*加权血管成像（ESWAN）序列的R2*值与子宫内膜癌（Endometrial carcinoma，EC）病理类型、肌层浸润深度、脉管浸润、侵犯转移的关系，探讨EC的生物学行为。方法：回顾性分析122例行1.5T MRI检查（含ESWAN序列），经手术病理诊断为EC的影像资料，测量EC病灶的R2*值。将所有患者分别分为4个配对组，即高风险病理类型组（Ⅰ型癌G3级与Ⅱ型癌，A1组）与低风险病理类型组（Ⅰ型癌G1、G2级，B1组），深肌层浸润组（A2组）与非深肌层浸润组（B2组），脉管浸润组（A3组）与非脉管浸润组（B3组），侵犯转移组（Ⅱ、Ⅲ、Ⅳ期，A4组）与非侵犯转移组（Ⅰ期，B4组）。采用独立样本t检验比较各配对组R2*值的差异；根据ROC曲线下面积（AUC）评估R2*值对EC高风险病理类型、深肌层浸润、脉管浸润、侵犯转移的诊断效能，找出相应界值。结果：A1组40例，B1组82例；A2组44例，B2组78例；A3组25例，B3组97例；A4组27例，B4组95例。4个配对组的R2*值分别为（17.60±4.02） Hz vs. （12.81±2.66） Hz，（17.57±3.96） Hz vs. （12.58±2.40） Hz，（18.62±4.68） Hz vs. （13.29±2.75） Hz，（18.33±4.22） Hz vs. （13.26±2.94） Hz，差异均具有统计学意义（t=6.840、7.613、5.456、5.858，P<0.001）。R2*值对EC高风险病理类型、深肌层浸润、脉管浸润、侵犯转移的AUC分别为0.856、0.876、0.834、0.855，预估EC高风险病理类型、深肌层浸润、脉管浸润、侵犯转移的界值分别为R2*值≥15.24 Hz、R2*值≥14.76 Hz、R2*值≥14.67 Hz、R2*值≥15.25 Hz，灵敏度分别为77.50%、82.90%，79.50%、79.50%，特异度分别为84.00%、68.00%，85.20%、76.80%。结论：R2*值可作为MR非强化方式评估EC生物学行为的定量指标。

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	田士峰
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关键词 ：子宫内膜肿瘤, 磁共振成像

Abstract：Objective: To explore the biological behavior of endometrial carcinoma(EC) by analysing the correlation between the R2* value of enhanced T2 star-weighted angiography(ESWAN) sequence and the pathological type, depth of myometrium infiltration, vascular invasion, invasion and metastasis of EC. Methods: We retrospectively analyzed the imaging data of 122 cases who were diagnosed as EC by postoperative pathology and underwent 1.5T MRI examination(including ESWAN sequence). The R2* values of EC lesions were measured. All patients were divided into four pairing groups: the high-risk pathological type group(type Ⅰ grade 3 and type Ⅱ, group A1) and low-risk pathological type group(type Ⅰ grade 1 and grade 2, group B1), deep myometrial invasion group(group A2) and non deep myometrial invasion group(group B2), vascular invasion group(group A3) and non vascular invasion group(group B3), invasion and metastasis group(stage Ⅱ, Ⅲ and Ⅳ, group A4) and non invasion and metastasis group(stage Ⅰ, group B4). The R2* values of the paired groups were compared by independent sample t test. The diagnostic efficiency of R2* in the diagnosis of EC high-risk pathological type, deep myometrial invasion, vascular invasion, invasion and metastasis was evaluated by receiver operator characteristic(ROC) curve, and the corresponding thresholds were found. Results: There were 40 cases in group A1, 82 cases in group B1, 44 cases in group A2, 78 cases in group B2, 25 cases in group A3, 97 cases in group B3, 27 cases in group A4 and 95 cases in group B4. The R2* values of the four pairing groups were (17.60±4.02) vs. (12.81±2.66) Hz, (17.57±3.96) vs. (12.58±2.40) Hz, (18.62±4.68) vs. (13.29±2.75) Hz, (18.33±4.22) vs. (13.26±2.94) Hz, respectively, and the differences had statistically significant(t=6.840, 7.613, 5.456, 5.858, P<0.001). The AUC of R2* values for EC high-risk pathological type, deep myometrial invasion, vascular invasion, invasion and metastasis were 0.856, 0.876, 0.834 and 0.855, respectively. The thresholds for predicting high-risk pathological type, deep myometrial invasion, vascular invasion, invasion and metastasis of EC were R2* value≥15.24 Hz, R2* value≥14.76 Hz, R2* value≥14.67 Hz, R2* value≥15.25 Hz, respectively. The sensitivity and specificity were 77.50% and 84.00%, 82.90% and 68.00%, 79.50% and 85.20%, 79.50% and 76.80%, respectively. Conclusion: R2* value can be used as a quantitative index for evaluating the biological behavior of EC in non-enhancement MR.

Key words： Endometrial neoplasms Magnetic resonance imaging

收稿日期: 2018-02-13

PACS:	Ｒ737.33
	Ｒ445.2

基金资助:首都科技领军人才培养工程（Z181100006318003）。

通讯作者: 刘爱连，大连医科大学附属第一医院放射科，116011。E-mail：cjr.liuailian@vip.163.com

作者简介: 田士峰（1987-），男，辽宁大连人，主治医师。E-mail：TSF253356@163.com

引用本文:

田士峰，刘爱连，宋清伟，刘静红，孙美玉，朱雯. 初探R2*值定量评估子宫内膜癌生物学行为的价值[J]. 中国临床医学影像杂志, 2019, 30(2): 126-130.
TIAN Shi-feng, LIU Ai-lian, SONG Qing-wei, LIU Jing-hong, SUN Mei-yu, ZHU Wen. The value of R2* in quantitative evaluation of the biological behavior of endometrial carcinoma: a preliminary study. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(2): 126-130.

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http://www.jccmi.com.cn/CN/10.12117/jccmi.2019.02.013 或 http://www.jccmi.com.cn/CN/Y2019/V30/I2/126

[1]Sasada S, Yunokawa M, Takehara Y, et al. Baseline risk of recurrence in stage Ⅰ-Ⅱ endometrial carcinoma[J]. J Gynecol Oncol, 2018, 29(1): e9.
[2]Modh A, Ghanem AI, Burmeister C, et al. What Is the Optimal Adjuvant Treatment Sequence for Node-Positive Endometrial Cancer Results of a National Cancer Database Analysis[J]. Int J Gynecol Cancer, 2018, 28(2): 248-253.
[3]Bendifallah S, Ballester M, Dara E. et al. Endometrial cancer: Predictive models and clinical impact[J]. Bull Cancer, 2017, 104(12): 1022-1031.
[4]Guo Y, Wang P, Wang P, et al. Myometrial invasion and overall staging of endometrial carcinoma: assessment using fusion of T2-weighted magnetic resonance imaging and diffusion-weighted magnetic resonance imaging[J]. Onco Targets Ther, 2017, 10: 5937-5943.
[5]Tian S, Liu A, Zhu W, et al. Difference in Diffusion-Weighted Magnetic Resonance Imaging and Diffusion Tensor Imaging Parameters Between Endometrioid Endometrial Adenocarcinoma and Uterine Serous Adenocarcinoma: A Retrospective Study[J]. Int J Gynecol Cancer, 2017, 27(8): 1708-1713.
[6]Deng L, Wang QP, Yan R, et al. Combined subjective and quantitative analysis of magnetic resonance images could improve the diagnostic performance of deep myometrial invasion in endometrial cancer[J]. Clin Imaging, 2017, 43: 69-73.
[7]Ueno Y, Forghani B, Forghani R, et al. Endometrial Carcinoma: MR Imaging-based Texture Model for Preoperative Risk Stratification—A Preliminary Analysis[J]. Radiology, 2017, 284(3): 748-757.
[8]Ji S, Zhang S, Mao Z, et al. Quantitative assessment of iron deposition in Parkinson’s disease using enhanced T2 star-weighted angiography[J]. Neurol India, 2016, 64(3): 428-35.
[9]田士峰，刘爱连，李烨，等. R2*值预估子宫内膜样腺癌病理分级的价值[J]. 中国医学影像学杂志，2016，24（11）：864-867.
[10]Xin JY, Gao SS, Liu JG, et al. The value of ESWAN in diagnosis and differential diagnosis of prostate cancer: Preliminary study[J]. Magn Reson Imaging, 2017, 44: 26-31.
[11]赵宏伟，陆忠烈，吴卿杰，等. 外伤性蛛网膜下腔出血致中枢神经系统表面铁质沉积症的MRI评价[J]. 实用放射学杂志，2017，33（2）：186-189.
[12]孙成凤，韩雨，吴准，等. ESWAN评估子宫肌瘤高强度聚焦超声消融术的应用研究[J]. 实用医学杂志，2017，33（16）：2761-2764.
[13]刘剑羽，周延. MRI在女性生殖系统恶性肿瘤诊断、分期和疗效评价中的价值[J]. 中华放射学杂志，2015，49（5）：323-327.
[14]Rauh-Hain JA, Diver E, Meyer LA, et al. Patterns of care, associations and outcomes of chemotherapy for uterine serous carcinoma: analysis of the National Cancer Database[J]. Gynecol Oncol, 2015, 139(1): 77-83.
[15]Fukunaga T, Fujii S, Inoue C, et al. Accuracy of semiquantitative dynamic contrast-enhanced MRI for differentiating type Ⅱ from type Ⅰ endometrial carcinoma[J]. J Magn Reson Imaging, 2015, 41(6): 1662-1668.
[16]Lucic N, Draganovic D, Sibincic S, et al. Myometrium Invasion, Tumour Size and Lymphovascular Invasion as a Prognostic Factor in Dissemination of Pelvic Lymphatics at Endometrial Carcinoma[J]. Med Arch, 2017, 71(5): 325-329.
[17]Fares R, Kehoe S, Shams N. Preoperative Prediction of Lymph Nodal Metastases in Endometrial Carcinoma: Is it Possible?: A Literature Review[J]. Int J Gynecol Cancer, 2018, 28(2): 394-400.
[18]Amkreutz LCM, Pijnenborg JMA, Joosten DWL, et al. Contribution of cervical cytology in the diagnostic work-up of patients with endometrial cancer[J]. Cytopathology, 2018, 29(1): 63-70.
[19]Dobrzycka B, Mackowiak-Matejczyk B, Kinalski M, et al. Pretreatment serum levels of bFGF and VEGF and its clinical significance in endometrial carcinoma[J]. Gynecol Oncol, 2013, 128(3): 454-460.
[20]Mahecha AM, Wang H. The influence of vascular endothelial growth factor-A and matrix metalloproteinase-2 and -9 in angiogenesis, metastasis, and prognosis of endometrial cancer[J]. Onco Targets Ther, 2017, 10: 4617-4624.
[21]Coenegrachts L, Schrauwen S, Van Bree R, et al. Increased expression of placental growth factor in high-grade endometrial carcinoma[J]. Oncol Rep, 2013, 29(2): 413-418.
[22]Kotowicz B, Fuksiewicz M, Jonska-Gmyrek J. Clinical significance of pretreatment serum levels of VEGF and its receptors, IL-8, and their prognostic value in type Ⅰ and Ⅱ endometrial cancer patients[J]. PLoS One, 2017, 12(10): e0184576.
[23]Saraiva AL, Payan-Carreira R, Gartner F, et al. An immunohistochemical study on the expression of sex steroid receptors, Ki-67 and cytokeratins 7 and 20 in feline endometrial adenocarcinomas[J]. BMC Vet Res, 2015, 11: 204.
[24]Stoenescu VE, Niculescu M, Novac L, et al. Immunohistochemical reaction of the glandular epithelium in endometrial hyperplasia compared to endometrial carcinoma[J]. Rom J Morphol Embryol, 2017, 58(3): 791-800.
[25]Stefansson IM, Salvesen HB, Immervoll H, et al. Prognostic impact of histological grade and vascular invasion compared with tumour cell proliferation in endometrial carcinoma of endometrioid type[J]. Histopathology, 2004, 44(5): 472-479.
[26]Yu CG, Jiang XY, Li B, et al. Expression of ER, PR, C-erbB-2 and Ki-67 in Endometrial Carcinoma and their Relationships with the Clinicopathological Features[J]. Asian Pac J Cancer Prev, 2015, 16(15): 6789-6794.
[27]Gheytanchi E, Mehrazma M, Madjd Z. Expression of Ki-67, p53 and VEGF in pediatric neuroblastoma[J]. Asian Pac J Cancer Prev, 2014, 15(7): 3065-3070.
[28]Ernst BP, Mikstas C, St?觟ver T, et al. Association of eIF4E and SPARC Expression with Lymphangiogenesis and Lymph Node Metastasis in Hypopharyngeal Cancer[J]. Anticancer Res, 2018, 38(2): 699-706.
[29]夏伟兰，沈丹婷，麦慧芬，等. eIF4E 和Ki-67在子宫内膜癌组织中的表达及意义[J]. 山东医药，2015，55（1）：23-25.
[30]Miranda Galvis M, Santos-Silva AR, Freitas Jardim J, et al. Different patterns of expression of cell cycle control and local invasion-related proteins in oral squamous cell carcinoma affecting young patients[J]. J Oral Pathol Med, 2018, 47(1): 32-39.
[31]Xiao W, Dong X, Zhao H, et al. Expression of MIF and c-erbB-2 in endometrial cancer[J]. Mol Med Rep, 2016, 13(5): 3828-3834.
[32]郭东辉，沈丹华，郑文新. 有关子宫内膜癌规范化病理报告的探讨[J]. 中华病理学杂志，2014，43（2）：139-142.
[33]Cabral T, Lima LH, Mello LGM, et al. Bevacizumab Injection in Patients with Neovascular Age-Related Macular Degeneration Increases Angiogenic Biomarkers[J]. Ophthalmol Retina, 2018, 2(1): 31-37.
[34]庄晓苹，董晓峰，林琼琼. RON、HGF在子宫内膜癌中的表达及临床意义[J]. 现代实用医学，2017，29（7）：911-912.